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Ask the Doctor January 2014 Issue

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Dear Doctor January 2014

Letters to Tufts Veterinarians

Post-diagnosis management

Q We live with three indoor-outdoor cats: Dusty, a 10-year-old male mackerel tabby, Mokie, his sister, and Rascal, a three-year-old male orange tabby. Our yard is enclosed with cyclone fencing with cat fencing on top. Each year, we take our cats to the veterinary clinic for their annual physical exams and immunizations.

Last year, Dusty started jumping, running and then frantically licking himself. Our veterinarian said that he has hypersensitive nerve endings that make him feel like someone is sticking him with a pin. She prescribed a liquid, phenobarbital elixir, at a dose of 20mg/5ml. This medicine did not seem to have any real effect, other than Dusty not being able to jump as high as usual. Our veterinarian said the medicine would make Dusty sleepy, but that didn’t happen. This cat is strong and wiry and the two of us are unable to medicate him. We tried putting it in his food without success. We simply gave up, but he still has the problem. Do you have any suggestions?

Kathleen Seibel

A Dear Kathleen: It sounds to me as if Dusty may have feline hyperesthesia syndrome (FHS). No one is quite sure what causes this problem, but theories range from a seizure disorder to a compulsive behavior (or somewhere in between). Your veterinarian’s first line of treatment with phenobarbital was quite reasonable, though I can understand your cat’s reluctance to take the medicine in that form since the “elixir” contains alcohol and fruit flavor.

Perhaps your difficulty in administering it caused Dusty not to receive therapeutic doses and this may have accounted for its lack of success. Phenobarbital often does control FHS if a therapeutic blood level is obtained. It may be worth revisiting the anti-seizure approach using either a cat-friendly formulation of phenobarbital or a different anti-seizure drug, such as Keppra. Alternatively, an anti-compulsive medication like fluoxetine (ProzacŪ) can be tried. This latter treatment often meets with success either because of fluoxetine’s mood-stabilizing effects or because of the anti-compulsive effects of this drug.

Nicholas Dodman, BVMS

Animal Behavior Clinic Director

Cummings School of

Veterinary Medicine

At Tufts University

Virus testing in kittens

Q I trapped two stray kittens last year and had them treated for ringworm. They were neutered and given two rounds of kitten vaccinations. They also had bad breath so my veterinarian cleaned their teeth and needed to extract some teeth. One kitten’s dental problems had migrated into the root.

In trying to pinpoint a cause (other than juvenile gingivitis), my veterinarian tested the young cats for herpesvirus and calicivirus. She sent the test results to the Texas Veterinary Medical Diagnostic Laboratory and the results came back positive for feline calicivirus at “1:256” for both cats. I’m not sure exactly what that means. I had a different test performed by another veterinarian — a PCR test — and it came back negative on both cats.

I am confused and concerned by the conflicting test results. I am afraid to expose them to my cats, especially one I have who suffers from chronic allergies and has only had minimal vaccinations. The cats are currently isolated from our other cats in my household. They show no signs of calicivirus or upper respiratory problems. Is there any way to say with certainty that they are negative? Do you see any reasons not to introduce them to other cats who could be at risk?

Donna Poulos

A Dear Donna: Your discussion centers around two common viruses of cats — herpes and calicivirus — which cause, in most cases, mild and self-limiting upper respiratory infections, commonly referred to as “colds.”

You may have gone a bit further diagnostically than I would have recommended. Since common vaccines contain both herpesvirus and calicivirus, it is not unexpected for your cats to have antibodies against the viruses (as detected by the “SN,” or antibody test). The detection of antibodies does not confirm infection, but merely indicates that vaccination has been performed and that your cat’s immune systems have responded appropriately. The “PCR” test, which looks for particles of the actual virus, was negative. Without getting deeply into the pros and cons of PCR testing, this would suggest that active shedding of the virus is not occurring at the time testing was performed. This suggests that contagiousness to other cats would not be present.

Unfortunately, herpesvirus can reactivate and be shed intermittently at any time. So there is no way to say that a cat will never shed herpesvirus in the future. The story for calicivirus is similar, although some researchers feel that lifelong cure may occur in some cases.

The bottom line is that I don’t commonly test for either calicivirus or herpesvirus. I just assume that these viruses may be present and that the introduction of new cats into a household has the chance to trigger a round of upper respiratory infections. But colds are, in most cases, not a big deal. There’s plenty of other infectious disease that should be checked for (such as feline leukemia virus, feline immunodeficiency virus, parasites and ringworm) when new cats are introduced, however, my concern about herpesvirus and calicivirus is very low. I wouldn’t worry about the possible spread of cold viruses, and as long as they are otherwise healthy, introduce your new cats to the house.